Psychology News & Resources

A computerized self help intervention may help adolescents who suffer from depression. The specialized computer therapy acts much the same way as they do from one-to-one therapy with a clinician, according to a study published on BMJ.

Depression is common in adolescents, but many are reluctant to seek professional help. So researchers from the University of Auckland, New Zealand, set out to assess whether a new innovative computerized cognitive behavioral therapy intervention called SPARX could reduce depressive symptoms as much as usual care can.
SPARX is an interactive 3D fantasy game where a single user undertakes a series of challenges to restore balance in a virtual world dominated by GNATs (Gloomy Negative Automatic Thoughts). It contains seven modules designed to be completed over a four to seven week period. Usual care mostly involved face-to-face counseling by trained clinicians.

The research team carried out a randomized controlled trial in 24 primary healthcare sites across New Zealand. All 187 adolescents were between the ages of 12 and 19, were seeking help for mild to moderate depression and were deemed in need of treatment by primary healthcare clinicians. One group underwent face-to-face treatment as usual and the other took part in SPARX.

Participants were followed up for three months and results were based on several widely used mental health and quality of life scales.

Results showed that SPARX was as effective as usual care in reducing symptoms of depression and anxiety by at least a third. In addition significantly more people recovered completely in the SPARX group (31/69 (44%) of those who completed at least four homework modules in the SPARX group compared with 19/83 (26%) in usual care).

When questioned on satisfaction, 76/80 (95%) of SPARX users who replied said they believed it would appeal to other teenagers with 64/80 (81%) recommending it to friends. Satisfaction was, however, equally high in the group that had treatment as usual.

The authors conclude that SPARX is an “effective resource for help seeking adolescents with depression at primary healthcare sites. Use of the program resulted in a clinically significant reduction in depression, anxiety, and hopelessness and an improvement in quality of life.” They suggest that it is a potential alternative to usual care and could be used to address unmet demand for treatment. It may also be a cheaper alternative to usual care and be potentially more easily accessible to young people with depression in primary healthcare settings.

The Experience of Recurring Panic Attacks

To understand panic disorder with agoraphobia, we must first talk about panic attacks. Sudden and recurring panic attacks are the hallmark symptoms of panic disorder. If you have never had recurring panic attacks, it may be hard to understand the difficulties your friend or loved one is going through. During a panic attack, the body’s alarm system is triggered without the presence of actual danger. The exact cause of why this happens is not known, but it is believed that there is a genetic and/or biological component.

Sufferers often use the terms fear, terror and horror to describe the frightening symptoms of a full-blown panic attack. But even these frightening words can’t convey the magnitude of the consuming nature of panic disorder. The fear becomes so intense that the thought of having another panic attack is never far from conscious thought. Incessant worry and feelings of overwhelming anxiety may become part of your loved one’s daily existence.

These Intense Symptoms Must Mean Something…Something Terrible

At the onset of panic disorder, your loved one may be quite certain they are suffering from a heart condition or other life-threatening illness. This may mean trips to the nearest emergency room and intensive testing to rule out physical disease. But, even when he or she is assured that these symptoms are not life-threatening, it does little to put his or her mind at ease. The feelings experienced during panic attacks are so overwhelming and uncontrollable, sufferers are convinced they are going to die or are going crazy.

A New Way of Life Emerges: Fear and Avoidance

So frightening are the symptoms of panic disorder, that your loved one may go to any and all lengths to avoid another attack from occurring. This may include many avoidant types of behavior and the development of agoraphobia. But, despite the efforts to avoid another panic episode, the attacks continue without rhyme or reason. There is no place to escape, and the sufferer becomes a prisoner of an insidious and illogical fear. Without appropriate treatment, your loved one may become so disabled that he or she is unable to leave his or her home at all.

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Self Image Is Redefined

At times, we’ve all experienced nervousness, anxiousness, fear and, perhaps, even terror or horror. But in the midst of a catastrophic event, we understand these symptoms. Once the event is over, so, too, are the symptoms. But, imagine reliving these symptoms over and over again, without any warning or explanation.

This type of fear is life-changing. As abilities become inabilities, things once taken for granted, like going to into a store, become anxiety-filled events. Some enjoyable activities, like going to concerts or movies, may be avoided altogether. It is not uncommon for sufferers to experience a sense of shame, weakness and embarrassment as their self-image is redefined by fear.

Panic disorder is not just being nervous or anxious. Panic disorder is not just about the fear, terror and horror experienced during a full-blown panic attack because it does not end when the panic subsides. It is a disorder that is quick to invade and can alter one’s very essence, redefine one’s abilities and take over every aspect of one’s life.

Your Role As A Support Person

As a support person, you can play an important role in your loved one’s recovery process. Understanding what panic disorder is, and what it is not, will help you on this journey. Author Ken Strong provides a lot of information for supporting a person with panic disorder in his book, Anxiety:The Caregivers, Third Edition.

Girls appear to be “protected” from showing antisocial behaviour until their teenage years, new research from the University of Cambridge has found.

The study sheds new light on antisocial behaviour in girls compared with boys and suggests that rather than violence or antisocial behaviour simply reflecting bad choices, the brains of people with antisocial behaviour may work differently from those who behave normally.

Until now, little research has been done on antisocial behaviour (Conduct Disorder) in girls. According to Cambridge Neuroscientist Dr Graeme Fairchild of the Department of Psychiatry, lead author of the study:

“Almost nothing is known about the neuropsychology of severe antisocial behaviour in girls. Although less common in girls than boys, UK crime figures show that serious violence is increasing sharply in female adolescents.”

The study, published online this month in Biological Psychiatry, compared a group of 25 girls, aged 14–18 years-old, with high levels of antisocial and/or violent behaviour with a group of 30 healthy controls.“Most of our participants had major difficulties controlling their temper, lashing out and breaking things around their homes when they got angry, and had often been involved in serious fights. Several had convictions for violent offences and some had been to prison for assault,” Dr Fairchild explains.

Dr Fairchild and colleagues measured the girls’ ability to recognise the six primary facial expressions – anger, disgust, sadness, fear, surprise and happiness. They found that girls with antisocial behaviour made a large number of errors when asked to recognise anger and disgust, but had no problems recognising other facial expressions.

According to Dr Fairchild: “Our findings suggest that antisocial behaviour or violence may not simply reflect bad choices but that, at some level, the brains of individuals with antisocial behaviour may work differently. This might make it harder for them to read emotions in others – particularly to realise that someone is angry with them – and to learn from punishment.”

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The study also shows that although girls and boys with severe antisocial behaviour have the same problems recognising emotions, the girls – whose problems began when they were teenagers – more closely resembled boys whose antisocial behaviour began in childhood.

Boys with childhood-onset Conduct Disorder have difficulties recognising anger and disgust, but those with adolescence-onset Conduct Disorder do not.“This suggests that there are interesting differences in antisocial behaviour between girls and boys, with girls being protected from showing antisocial behaviour until their teenage years for reasons we don’t yet understand,”Dr Fairchild says.

The next phase of the research involves a brain scanning study. “As far as we know, this will be the first functional neuroimaging study ever carried out in girls with severe antisocial behaviour,” Dr Fairchild says.

Around five percent of school-age children would meet criteria for Conduct Disorder, but it is approximately three to four times more common in boys than girls. A range of factors – ranging from physical abuse in childhood to being diagnosed with Attention-Deficit/Hyperactivity Disorder – make it more likely that someone will develop Conduct Disorder.

It is difficult to treat using psychological therapy, and there are no effective drug treatments, but a new form of therapy called Multi-Systemic Therapy is currently being trialled in the UK and shows promise in treating antisocial behaviour.

Regular exercise can play an important a role in improving the physical and mental wellbeing of individuals with schizophrenia, according to a review published in The Cochrane Library. Following a systematic review of the most up-to-date research on exercise in schizophrenia, researchers concluded that the current guidelines for exercise should be followed by people with schizophrenia just as they should by the general population.

“Current guidelines for exercise appear to be just as acceptable to individuals with schizophrenia in terms of potential physical and mental health benefit,” says lead researcher Guy Faulkner of the Faculty of Physical Education and Health at the University of Toronto, Canada. “So thirty minutes of moderate physical activity on most or all days of the week is a good goal to aim for. Start slowly and build up.”

Schizophrenia is a serious mental illness affecting four in every 1,000 people. It is already known that exercise can improve mental health, but so far there has been only limited evidence of effects in schizophrenia. The new review focused on three recent small studies that compared the effects of 12–16 week exercise programmes, including components such as jogging, walking and strength training, to standard care or yoga.

The researchers found that exercise programmes improved mental state for measures including anxiety and depression, particularly when compared to standard care. Changes in physical health outcomes were seen but they were not significant overall. However, the researchers suggest this may be due to the short timescale of the trials.

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Two previous reviews have found exercise therapy to be beneficial in schizophrenia, but called for more rigorous research. “This new review suggests that such calls are starting to be addressed,” says Faulkner. “But we still need more research that will help us learn how we can get individuals with schizophrenia engaged in exercise programmes in the first place, and how such programmes can be developed and implemented within mental health services. That’s one of the biggest challenges for this type of intervention.”

Researchers from the University of Essex found that as little as five minutes of a “green activity” such as walking, gardening, cycling or farming can boost mood and self esteem.

“We believe that there would be a large potential benefit to individuals, society and to the costs of the health service if all groups of people were to self-medicate more with green exercise,” Barton said in a statement about the study, which was published in the journal Environmental Science & Technology.

Many studies have shown that outdoor exercise can reduce the risk of mental illness and improve a sense of well-being, but Jules Pretty and Jo Barton, who led this study, said that until now no one knew how much time needed to be spent on green exercise for the benefits to show.

Barton and Pretty looked at data from 1,252 people of different ages, genders and mental health status taken from 10 existing studies in Britain.

They analyzed activities such as walking, gardening, cycling, fishing, boating, horse-riding and farming.

They found that the greatest health changes occurred in the young and the mentally ill, although people of all ages and social groups benefited. The largest positive effect on self-esteem came from a five-minute dose of “green exercise.”

All natural environments were beneficial, including parks in towns or cities, they said, but green areas with water appeared to have a more positive effect.

Video still of an children's fashion shoot image which was released as part of a report into the sexualisation of children.

There has been an increasing amount of concern amongst health professionals regarding the rise of “tweenage” culture, the target marketing of pre-adolescent children, particularly girls, with clothing and cultural images that seem to be pushing them towards adulthood way too early. The following newspaper articles from this weekend’s newspapers highlight this disturbing trend, and offer up some food for thought for parents.

PARENTS are sending girls as young as nine to have painful beauty treatments.

Beauticians say that young children are being brought into salons by parents to undergo painful hair removal treatments.

NSW Community Services Minister Linda Burney criticised the paractice, and although she stopped short of calling it abuse, she said that mothers should not force their daughters to mature too quickly.

“Most people would be pretty aghast that girls as young as nine would feel that they need to have their legs waxed,” Ms Burney said.

“It raises the broader issue of children growing up too quickly and brings up the issue of sexualisation of children. Children should be allowed to be children and not feel they need to emulate what they see in gossip magazines and the advertising industry.”

Too young, too painful

She warned that the sexualisation of young girls through such beauty treatments could lead to depression, anxiety and eating disorders.

Parents needed to use common sense in deciding when the right time was to allow their child to wax, but there was also an onus on the beauty industry, although regulation was not the answer, she said.

“At the end of the day, it is really on the proprietor to make a particular decision about whether they will allow that client in the salon,” Ms Burney said.

Bullied

Ms Burney said that there may be exceptional circumstances, for example, if a child was being teased or bullied because they were particularly hairy.

Child sexualisation expert and humanities and social science lecturer at Charles Sturt University, Emma Rush, said she was “disturbed” parents were taking young children to have the procedure.

“It might seem like a nice thing to do for a little girl, but not at that age. Mid-teens, sure. Children aged nine or younger have not got the cognitive (capacity). They don’t have the need for it. There is the question of whether they are ready to cope with the attention that can attract,” Dr Rush said.

She said girls in primary schools were now exhibiting depression, anxiety and eating disorders, which had all been strongly linked to sexualisation.

“Parents also need to think about the message that this is sending to their children,” she said.

“It is very limiting for a child how much focus there is on looks.”

She said children should never be pressured to undergo such beauty treatments and discouraged from starting them until at least 14.

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Alison Godfrey

In the article NSW Community Services Minister Linda Burney said mothers should not force their daughters to mature too quickly.

“Most people would be pretty aghast that girls as young as nine would feel that they need to have their legs waxed,” Ms Burney said.

“It raises the broader issue of children growing up too quickly and brings up the issue of sexualisation of children. Children should be allowed to be children and not feel they need to emulate what they see in gossip magazines and the advertising industry.”

She warned that the sexualisation of young girls through such beauty treatments could lead to depression, anxiety and eating disorders.

Firstly I was horrified, then I wondered – are they really forcing them? Or are nine-year-old girls asking their parents if they can shave their legs and mums are taking them to the salon instead? Are mums just buckling to pester power?

Either way, it does raise the issue of sexualisation of young children. The story about leg waxing follows a run of other stories of inappropriate products aimed at children. Take a look at this padded bra for seven-year-olds which a UK retailer was forced to remove from sale after The Sun called the bra a “paedo (pedophile) bikini”.

Last month, Professor Newman, the president of The Royal Australian and New Zealand College of Psychiatrist said she had seen four-year-olds who wanted to go on diets. She said the overt sexualisation of society was pushing teenage concerns about body image, “sexiness” and of being a “worthwhile individual” well into a child’s first years of life.

Last week I was shopping for clothes for my soon to be born baby girl. I was shocked by the by the rock star style mini-skirts and leather jackets in Best and Less. I just wanted something cute, simple, elegant and baby like. What girl under one wears black leather and studs? What are they thinking?

But then, we should also be asking what are the parents thinking? Because ultimately it is the parents that agree to buy these items for children. It is parents who say yes, rather than no.

Yesterday I made my husband turn off Video Hits because CJ was watching a scantily clad woman gyrating to hip hop music. It made me uncomfortable. It wasn’t appropriate for a two-year-old. I can only imagine the conversations that must generate in families with older children.

When my baby girl is born in, hopefully just over 10 weeks, I know that I will probably be even more protective with her. And leg waxing will have to wait until I am ready for it.

Cognitive behaviour therapy (CBT) via the internet is just as effective in treating panic disorder (recurring panic attacks) as traditional group-based CBT. It is also efficacious in the treatment of mild and moderate depression. This according to a new doctoral thesis soon to be presented at Karolinska Institutet.

“Internet-based CBT is also more cost-effective than group therapy,” says Jan Bergström, psychologist and doctoral student at the Center for Psychiatry Research. “The results therefore support the introduction of Internet treatment into regular psychiatry, which is also what the National Board of Health and Welfare recommends in its new guidelines for the treatment of depression and anxiety.”

It is estimated that depression affects some 15 per cent and panic disorder 4 per cent of all people during their lifetime. Depression can include a number of symptoms, such as low mood, lack of joy, guilt, lethargy, concentration difficulties, insomnia and a low zest for life. Panic disorder involves debilitating panic attacks that deter a person from entering places or situations previously associated with panic. Common symptoms include palpitations, shaking, nausea and a sense that something dangerous is about to happen (e.g. a heart attack or that one is going mad).

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It is known from previous studies that CBT is an effective treatment for both panic disorder and depression. However, there is a lack of psychologists and psychotherapists that use CBT methods, and access to them varies greatly in Sweden as well as in many other countries. Internet-based CBT has therefore been developed, in which the patient undergoes an Internet-based self-help programme and has contact with a therapist by email.

The present doctoral thesis includes a randomised clinical trial of 104 patients with panic disorder and compares the effectiveness of Internet-based CBT and group CBT within a regular healthcare service. The study shows that both treatments worked very well and that there was no significant difference between them, either immediately after treatment or at a six-month follow-up. Analyses of the results for the treatment of depression show that Internet-based CBT is most effective if it is administered as early as possible. Patients with a higher severity of depression and/or a history of more frequent depressive episodes benefited less well from the Internet treatment.

Jan Bergström works as a clinical psychologist at the Anxiety Disorders Unit of the Psychiatry Northwest division of the Stockholm County Council. This research was also financed by the Stockholm County Council.

“Thanks to our research, Internet treatment is now implemented within regular healthcare in Stockholm, at the unit Internetpsykiatri.se of Psychiatry Southwest, which probably makes the Stockholm County Council the first in the world to offer such treatment in its regular psychiatric services,” says Jan Bergström.

Compulsive collecting or Hoarding is a misunderstood and debilitating mental health issue. Many psychologists and counsellors never see someone with this condition as they very rarely present for help. This article from an Australian newspaper provides an excellent overview of the condition and issues underlying hoarding, and I have included links to two brilliant books co-authored by the researchers discussed in the article, who have developed a wholistic and novel approach to it’s treatment.

They may dress well or hold down a good job. But hoarders are unhappy people who suffer from a debilitating condition.

Every suburb has one. The elderly woman weaving through an overgrown backyard full of cardboard boxes, old tyres and discarded furniture. Cats perch on every surface; kittens roll about among the rusted drums and long grass.

Inside, behind closed curtains, the rooms are piled high with papers, cups, plates and bottles. Broken toys, old clothes and shopping bags spill across kitchen benches and floor, smothering the stove and filling the sink, neither of which has been used in years.

The stench of cat faeces, urine and food scraps fill the house.

To her neighbours, she is an oddity. Or a pest, bringing down house values and encouraging vermin.

But to therapists she is one of a growing band across Australia suffering from a debilitating condition known as compulsive hoarding, where people feel a need to collect and store items that seem useless to others.

Their homes become havens of insurmountable clutter and junk, often leaving them unable to sleep in their beds or use appliances. Many end up with electricity or gas supplies disconnected or their fridge and washing machines unusable because they fear their lifestyle will be revealed if they contact a tradesmen to make repairs.

This secrecy and shame make it difficult to know exactly how many people have the disorder.

Some experts think between 200,000 and 500,000 Australians compulsively hoard, but others put the figure closer to 800,000.

“It’s a sleeping giant,” Chris Mogan, a clinical psychologist and expert on hoarding, says. “There is no systematic estimate of how many hoarders there are in any Australian setting. I suspect there are many, many more out there than we are aware of.”

Louise Newman, the president of the Royal Australian and New Zealand College of Psychiatrists, agrees.

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“I’ve only seen one case in my career [because] these people usually only come to light when the council steps in and orders a clean-up. Hoarders desperately want to keep hoarding. They don’t want to be stopped.”

There is little research on the condition in Australia and not much in the way of funding or treatment programs, but experts are hopeful hoarding will be included in the next (fifth) edition of the Diagnostic and Statistical Manual of Mental Disorders, the bible used by mental health experts to diagnose psychiatric conditions.

Many sufferers fall between the cracks because hoarding is not a clinical diagnosis in its own right, but is seen more as an offshoot of obsessive compulsive disorder, muddled with depression, anxiety, panic disorder and low self-esteem.

“But it is different to OCD and once we get it in the DSM-V, therapists, psychiatrists, psychologists and social workers can then be trained in the management of it [and] we can attract funding for research,” Mogan says.

Jessica Grisham, a clinical psychologist who specialises in obsessive compulsive disorder, also believes compulsive hoarding should be included in the next edition as it requires specialised treatment.

She cites recent neural imaging studies in the US that showed that different parts of the brain were activated in hoarders than in obsessive compulsive disorder patients.

Mogan and Grisham agree that cognitive behaviour therapy, where sufferers are slowly taught to change their thought patterns, is more effective than medication alone.

But hoarders responded better to a specially adapted version of the therapy, developed by the American hoarding experts Gail Steketee and Randy Frost. It had been achieving success with about 60 per cent of hoarders – far more than standard cognitive behaviour therapy.

“But it has to be a long-term project. You don’t go in to someone’s place and do a sudden excavation against their will,” Grisham says.

“That’s a violation and it’s very traumatic for them. It might make great TV, but it’s not good clinically.”

Mogan agrees. A pay TV show, Hoarders, was damaging to the public’s understanding of the illness, because it focused on forcefully cleaning houses in three days.

“Within six to 12 months that house will be recluttered because it is a compulsion … they suffer a lot of grief after things are taken away.”

Mogan makes weekly home visits to hoarders, and focuses on getting them to reduce the associated dangers by ensuring their home has two exits for safety, and working appliances and smoke alarms.

“Just as we do with drugs and alcohol, we’re into harm minimisation. Once the house is safe, we gradually set more goals. If they are comfortable with that, they will continue to stay in touch and not reject us.”

Sometimes the problem extends beyond mounds of paperwork and clothes. Mogan and Grisham know patients who hoarded urine or fingernail clippings. Some stored their own faeces or collected one particular item, such as bicycles. One sufferer was hoarding so much junk, the only access to the house was a 30-centimetre gap at the top of the front door.

But for Allie Jalbert, of the RSPCA, the most distressing hoarders are those who keep scores of cats and dogs, all battling for attention and food on a crowded suburban block.

She has been calling for years to have hoarding classified as an illness in its own right to allow more people to receive treatment and put an end to the 100 per cent recidivism rate.

“Often, we find that hoarders might be treated for peripheral symptoms such as anxiety or depression, but their core problem, the hoarding, is not addressed. So once we have cleaned out the house, they reoffend, which is very, very frustrating for everyone involved,” Jalbert says.

Some people threatened suicide and had to be removed by police when faced with the prospect of giving up their animals or clutter.

“There’s a mixed bag of emotion when you deal with hoarders. Firstly, there is the concern for your personal safety but there is also a degree of empathy because often these people are quite emotional and attached to the animals. But it’s quite frustrating to see animals living in such horrific situations,” she says.

“I’ve seen bathtubs full of faeces and rubbish, sinks that no longer work, homes with no heating or cooling. Sometimes it’s quite an overwhelming experience.”

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Who develops the condition and why?

Some studies have shown that many hoarders have been brought up in households where chaos reigned. Some were neglected as children and witnessed pets being treated poorly.

Mogan accepts the aetiology is mostly unknown, but cites an Australian study that found sufferers reported failing to connect with their parents or growing up in households lacking emotional warmth.

“The lack of attachment causes them to become ambivalent about their identity and about other people. As a compensatory mechanism, they link with things, which they find more compelling, more predictable and dependable and less rejecting.”

But Grisham believes there is no real trigger, apart from children of hoarders being rewarded for saving things and getting punished for discarding. “Sometimes there is a traumatic head injury but those cases are very rare.”

The condition affects slightly more women than men but is found across all occupations, age groups and ethnicities. “And they are in relationships,” Mogan says. “Albeit strained ones.

“Some are going out to work, but they make sure no one comes to their house. They’re not agoraphobic. On the contrary, many hoarders go out a lot to escape. But their children’s lives can’t be normalised because they can never sit down for a meal or find space to do homework. It’s a real impost on the family experience.”

Mogan runs group therapy sessions in Melbourne and says that many patients do want to be cured.

“This condition is a disability and the source of quite a lot of human suffering and neglect. A lot of these people are quite relieved to get help.”

Yesterday I came across this amazing one-on-one interview with Temple. The video is a re-broadcast of an hour long intimate discussion with Temple about her life, her work and her journey with autism. If you are at all interested in the area of ASD you will want to watch this!

About Peter

Peter Brown BHMS (Hons) MPsychClin MAPS

I’m a Clinical Psychologist and have a private practice and consultancy in Brisbane Australia. I have 24 years experience in child, adult and family clinical psychology. I have a wonderful wife and three kids.

I like researching issues of the brain & mind, reading and seeking out new books and resources for myself and my clients. I thought that others might be interested in some of what I have found also, hence this blog…